YELLOW BRICK ROAD #2

Type B citation - potential risk if not corrected

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25A Case Management inspection was conducted at the facility by Licensing Program Analyst (LPA) Jen Patel and Licensing Program Manager (LPM) Mindy Mohr in response to an Unusual Incident Report (UIR) received 10/30/2025 involving a child sustaining a head injury while in care. During today’s visit, LPA and LPM met with the facility’s director Michelle Allen (D1), to discuss the incident and obtain additional details. During today's case management visit, LPA and LPM observed 25 children in care being supervised by 3 staff. LPA and LPM toured the outdoor play area and observed a metal climbing dome up against a fence and a tree with a stump that had a sharp edge. The climbing dome is an age-appropriate piece of childcare equipment. During the visit D1 reported that on 10/29/2025, she heard S1 call her name and said that C1 was bleeding. D1 stated that she was on the grassy area of the yard when the incident occurred but didn’t see the incident. Emergency personnel arrived to treat C1. D1 also called C1’s parents who decided to transport C1 to hospital to receive medical treatment. D1 further stated blood was observed on the tree stump. S1 and S2 both stated they were on the yard at the time of the incident but did not observe C1 get injured. S1 further stated paramedics said C1 hit the tree stump with their forehead causing the injury. Based on available information, it has been determined that adequate supervision was not provided on 10/29/25 when C1 received a injury on their head. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809 Deficiency page. Appeal Rights were provided. LPA provided handouts on Active Supervision to D1 during the visit. A notice of site visit was given to D1 and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative, Michelle Allen. NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr NAME OF LICENSING PROGRAM ANALYST: Jennifer Patel LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/06/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2025 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 3 FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form. DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies: Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care. Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care. PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency. CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of correctio

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25A Case Management inspection was conducted at the facility by Licensing Program Analyst (LPA) Jen Patel and Licensing Program Manager (LPM) Mindy Mohr in response to an Unusual Incident Report (UIR) received 10/30/2025 involving a child sustaining a head injury while in care. During today’s visit, LPA and LPM met with the facility’s director Michelle Allen (D1), to discuss the incident and obtain additional details. During today's case management visit, LPA and LPM observed 25 children in care being supervised by 3 staff. LPA and LPM toured the outdoor play area and observed a metal climbing dome up against a fence and a tree with a stump that had a sharp edge. The climbing dome is an age-appropriate piece of childcare equipment. During the visit D1 reported that on 10/29/2025, she heard S1 call her name and said that C1 was bleeding. D1 stated that she was on the grassy area of the yard when the incident occurred but didn’t see the incident. Emergency personnel arrived to treat C1. D1 also called C1’s parents who decided to transport C1 to hospital to receive medical treatment. D1 further stated blood was observed on the tree stump. S1 and S2 both stated they were on the yard at the time of the incident but did not observe C1 get injured. S1 further stated paramedics said C1 hit the tree stump with their forehead causing the injury. Based on available information, it has been determined that adequate supervision was not provided on 10/29/25 when C1 received a injury on their head. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809 Deficiency page. Appeal Rights were provided. LPA provided handouts on Active Supervision to D1 during the visit. A notice of site visit was given to D1 and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative, Michelle Allen. NAME OF LICENSING PROGRAM MANAGER: Melinda Mohr NAME OF LICENSING PROGRAM ANALYST: Jennifer Patel LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/06/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2025 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 3 FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form. DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies: Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care. Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care. PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency. CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of correctio